Baby 411 Blog

Infant cough and cold med recall

The major manufacturers of infant cough and cold preparations have voluntarily recalled 14 products from the market today, saying that there is too much risk of misuse or overdose of these products. They should be applauded for being proactive on this one.

This comes shortly before the Food and Drug Administration is scheduled to release a report next week about their investigation on these over the counter preparations.

The FDA was alerted to potential for overdose by the City of Baltimore Health Commissioner, who identified four children under three years of age whose cause of death was accidental overdose of cough and cold products.

As we all know, these products say "consult a physician" instead of offering a dosing guideline. Parents may then try to guess-timate what is the correct dose. To add to the confusion, some products are used to treat multiple symptoms and thus, contain two or even three different medications. If a parent then gives another medication, like a decongestant, the child may be accidentally be getting double doses of one product.

I, like most of my pediatrician colleagues, have never recommended these cough and cold remedies anyway. They have marginal benefit in relieving symptoms of the common cold or flu and don't make the disease go away any faster. And, clearly the risk outweighs the benefit.

I still recommend using saline nose drops (you can';t overdose on those!), a humidifier, and lots of TLC from Mom and Dad.

Reader Email: How do we give up swaddling?

Reader Joshua S. writes today:

I do have a question though that was not in the book, unless I missed it.  We have been swaddling our two month old son with one of those halo swaddles - the one that you put the baby in, zip it up, then there are wings that swaddle around the baby.  The baby sleeps really well in this.  We are trying to not swaddle him, but, it's not working (at all).  People say that I will know when he does not like to be swaddled anymore when he busts out of the swaddle.  The problem is that this swaddle zips and velcroes. It is impossible to bust out of.  Do you have any suggestions as to how to transition our son out of the swaddle and to sleep without it.  Obviously, he will grow out of the swaddle at some point, but I wanted to start doing the transition now.   If I unzip it, he constantly moves and then cries.  When I put him to sleep in the swaddle, he initially moves a lot in the swaddle, kicking his legs, and moving his hands (inside the swaddle).  Any suggestions are appreciated.  Thank you.

Happy to help. This is your homework assignment, due in the
next four weeks: get rid of it. Two reasons: 1. you want him to develop
sleep associations that you want to live with for a long time--so any sleep
crutches should be out of his world by three or four months of life. 2. if
he isn't moving around at night, the back of his head will become pretty
flat. So, while it is okay to continue it for a few more weeks, the
swaddler's days are numbered. Your son will be older in a few weeks and more
capable of soothing himself with fewer immature newborn reflexes.

The take home message: I would suggest quitting, cold turkey, by 3 months of age. Most babies like to move around at that point and have fewer of those newborn startle reflexes that wake them up when they move around. Your goal is to have the sleep habits you want to keep by 4 months, so transitioning to that goal is the plan. That will also help reduce the dreaded flat spot on the back of the head (plagiocephaly) that babies get when they are constantly sleeping in one position.

Dr Brown nipples and Evenflo glass bottles

Here's another alternative, from a pediatrician in Los Angeles:
Dr. Brown standard nipples do fit the Evenflo glass bottles (using the Evenflo "o" ring).

Breastflow and Avent Tempo liners

Sorry for the delay in responding (on vacation this week!). The Breastflow bottles DO contain BPA. However, the Avent Tempo disposable drop-in liners will fit into the bottle and do not seem to leak, and those are BPA-free.

Baby bottle alternatives

Many of the Dr. Brown bottle fans are wondering if there is an BPA free alternative that has a similar flow system.

One thing we discovered is that Breastflow bottles (also very popular for their flow system) are compatible with the Avent tempo bottle liner drop-ins.

You may want to give one a try and see how it goes!

RECALL: Vinyl bibs sold at Babies R Us, Toys R Us

Toys R Us and Babies R Us are recalling vinyl baby bibs from their stores when testing revealed that bibs from one supplier (from guess where--China) contained lead. These bibs were marketed under the names Koala Baby, Especially for Baby, and Disney Baby labels.

Here are the details:

TOYS “R” US, INC. ANNOUNCES PRECAUTIONARY STOP SALE ON ALL VINYL BIBS
Action Includes all Items Manufactured By Hamco, Inc., as Well as Other Vendors

WAYNE, NJ (August 17, 2007) - Toys “R” Us, Inc. announced today that as a precautionary measure it has removed all vinyl bibs manufactured by Hamco, Inc. and its other vendors from Toys “R” Us and Babies “R” Us store shelves.

Because of its strong commitment to safety, Toys “R” Us voluntarily adheres to the stringent California Proposition 65 standards for its testing of vinyl baby bibs. All of its vinyl bibs are tested against these requirements every six months by an independent testing facility. These bibs, including those manufactured by Hamco, passed these rigorous tests, including as recently as May 2007. However, the company noted that stores have received shipments since that time and therefore decided to conduct additional re-testing on these items.

Based on discussions with the Consumer Product Safety Commission staff, following the agency’s own tests conducted last week on certain Hamco bibs sold by Toys “R” Us, there were no instances of any hazardous levels of lead found in these products.

In recent days, Toys “R” Us asked Bureau Veritas, a world leader in independent testing, to re-test samples of all Hamco-manufactured bibs sold by the company. Among its findings, the Bureau Veritas tests found two samples of Hamco bibs that contained lead over the strict Toys “R” Us testing requirements. As a result of inconsistent results between the company’s May 2007 and August 2007 tests, Toys “R” Us has immediately stopped sale of these items in its stores. These bibs were sold to Toys “R” Us by Hamco and marketed under the Koala Baby, Especially for Baby and Disney Baby labels.

While not aware of any concerns regarding vinyl bibs made by other manufacturers, the company has temporarily removed all vinyl bibs from its store shelves to help minimize any potential consumer confusion and as an additional precautionary measure so that the company can voluntarily re-test these products.

In addition to its rigorous testing of all products prior to shipment to its stores, Toys “R” Us has recently increased its third party re-testing of products on store shelves. The company will continue to take decisive and aggressive action in ensuring the products it sells meet only the highest quality assurance standards.

The company said that customers who wish to return vinyl bibs purchased at any time from a Toys “R” Us or Babies “R” Us store may do so and receive a full refund. For questions or additional information, customers may call 1-800-869-7787.

New FDA Warning: Codeine and breastfeeding

Codeine is a popular pain medication that has been used routinely for moms who have had C-sections or pain after childbirth. It's not news that some of the medication passes through breastmilk in small amounts. But, new findings suggest that some women have a genetic predisposition to being "ultra-rapid metabolizers" of the medicine. In those women, the amount of codeine in their breastmilk may be significantly higher, leaving their babies at risk for side effects of the drug-like extreme sleepiness.

As a result, the FDA has issued a new warning about codeine and breastfeeding.

While there is a test available to see if a mom carries the CYP2D6 gene, it's currently not standard of care to perform this test routinely on all breastfeeding mothers. However, the highest risk group to have this gene are typically North Africans, Ethiopians and Saudi Arabians (16% to 28% of women in these groups carry the gene). Caucasians have a 1% to 10% chance of carrying the gene, blacks have a 3% chance, and Hispanics/Asians have a 1% chance.

So, can you use a codeine containing pain medication after delivery if you are nursing? Yes. But, you should be on the look out for a baby who is extremely sleepy and not waking up to feed--especially if you are in the high risk group who may carry the CYP2D6 gene. And, obviously, it's a good idea to wean as quickly as possible to acetaminophen or ibuprofen when you are starting to feel better.

Toy Recalls: Get the lead out!

Yes, first it was a toxic Thomas and dangerous Dora, now its bad Batman.

As you may have heard, there was another major toy recall for toys manufactured in China. Today’s alert instructs families to throw away some 9 million Mattel toys due to loose magnets and lead paint:

http://www.cpsc.gov/ (click on Recent Recalls)

Given recent events, we thought we’d get you up to speed on lead and our suggestions for how keep your kids safe.

Q. What is the problem with lead anyway?

A. Lead is a metallic element which is a known neurologic toxin. When it became apparent that lead could cause significant harmful effects in humans, even at low levels of exposure, it was removed from gasoline and paints in the 1970’s.

Blood levels of 10 micrograms/dl or more are considered toxic and may have adverse health effects. Kids under six years of age are most sensitive because the lead can impact the developing brain.

Most children do not have any symptoms when they are diagnosed with mildly elevated blood lead levels. However, potential effects include developmental delays, loss of developmental milestones (especially in language skills), and learning difficulties. More serious health consequences are also possible, especially with higher toxicity levels and chronic exposure.

Q. How can my child be exposed to lead in the environment?

A. The most significant exposure risk is in children who live in homes built before 1978. Lead paint dust can be ingested by young children, especially when they spend time crawling on the floor and putting their hands in their mouths. Lead water pipes can also be a source of exposure.

Lead continues to be used in products (paint, pottery glaze, cooking products, pigment in cosmetics, crayons, paints, medications) throughout the world, particularly in developing countries. And, when these products are imported into the U.S, we may be exposed to them.

Q. What should I do if my child has toys that are recalled?

A. Odds are, your child has not had a significant lead exposure even if you have more than one of the toys lying around your playroom. It’s a little more concerning if your child was using one of these toys as a teething toy or really enjoys exploring toys with his mouth.

It’s probably wise to bring up your concerns with your child’s doctor, and get a blood lead level drawn depending on your child’s possible risk of exposure. If your child’s blood lead level is less than 10 micrograms/dL, toss out the recalled toys and call it a day.

Plastic Baby Bottles: Are they safe?

Breaking news: Experts cite “concern” over polycarbonate baby bottles

Are certain plastic baby bottles dangerous? Readers of our new 3rd edition (out in stores now) may remember our discussion of the safety of polycarbonate baby bottles—and how a federal panel studying the issue was about to weigh in on the issue.

Well, the results are in. Here’s the scoop:

An independent review panel assigned by the National Institute of Environmental Health Sciences and the National Toxicology Program weighed in on the toxic plastics debate last week. Their conclusion: they have “some concerns” about chemical used to make polycarbonate bottles, Bisphenol A (BPA), potentially causing neurologic and behavioral problems in fetuses, infants, and children.

What does that mean for your baby and those baby bottles and sippy cups sitting in your kitchen? Here are the most common questions parents are asking, and our answers based on what we know.


Q. What the heck is BPA? Why is it dangerous?

Clear plastic baby bottles (as well as some food containers and water bottles) are made of polycarbonate, which contains a chemical called Bisphenol A (BPA). It is the BPA that makes the hard, clear plastic bottles . . . well, hard and clear.

Here’s the rub: BPA’s chemical bond with polycarbonate breaks down over time—especially with repeated washings or heating of the bottle. As a result, BPA may leach out of the plastic bottle or sippy cup . . . and into the liquid (that is, breast milk or formula). BPA has been used since the 1950’s in a variety of products and we know that humans ingest (and eliminate) small amounts of this substance on a daily basis considering 95% of humans studied have it in their urine.

While most data BPA comes from animal research, studies show even low-level BPA MAY be linked to everything from early puberty to breast cancer, to attention and developmental problems. It’s hard to say that humans will have the same health consequences, but there is certainly enough concern that it deserves investigating the effects on humans.

The Environmental Protection Agency has set an “acceptable” or “safe” level of daily BPA exposure to be 50 micrograms per body kilogram per day. However, some scientists worry that humans may be exposed to up to ten times that daily dose.

We wrote a detailed article on BPA and plastic baby bottles in our newly revised 3rd edition of Baby 411. It is available online at our website:

http://www.windsorpeak.com/baby411/bpa.html

Q. Do we really know that these bottles are dangerous to humans?

No, we don’t. There have been no human studies on BPA—so far, researchers have only found problems in animal research.

There is a split opinion here among scientists. The same federal panel that said it had “some concern” about behavioral and developmental problems in babies also stated that links to other ailments like birth defects and adult ailments were “negligible.”

That contrasts to the group of 38 scientists who last week called the threat from BPA as “significant.”

But the fact the federal panel said there were some concerns for the health of babies tipped the balance for us.

As a parent, we realize it can be hard to decide what to do when the debate is so heated. As always, our mantra is “show us the science.” We believe enough science is now in to recommend a change in course.

Q. Isn’t it a bit alarmist to say stop using these bottles?

The truth is we won’t know for YEARS if there is a human health problem. And, it could be YEARS more before the government decides to take some regulatory action.

Our opinion: if concerns exist today (and that is backed up by reputable scientific research), then why not try to limit your baby’s exposure to this chemical?

We suggest stop using polycarbonate baby bottles and sippy cups now. Since there are quite a few BPA-free bottles on the market (see below), we believe this is an easy call for parents.

Q. The Juvenile Products Manufacturer’s Association said plastic baby bottles are safe.

In a recent statement, the JPMA said the federal panels report on BPA “reaffirms the safety of plastic baby bottles.”

With all due respect to the fine folks at the JPMA, we’re not sure they were reading the same report we did. If they did, they would note this sentence: “The Expert Panel expressed some concern that Exposure to BPA causes neural and behavioral effects.”

Click here to read it:

http://cerhr.niehs.nih.gov/chemicals/bisphenol/draftBPA_MtgSumm080807.pdf

We realize you can argue that the panel didn’t call for the ban of products with BPA. But, that’s NOT what the panel was asked to do. It will now take years of debate among scientists, researchers and politicians as to the best course to take with BPA.

For the record, Avent told us they believe their bottles are safe and pose no health threat to babies.

Q. Which bottles should we NOT use? Which ones are BPA-free?

Polycarbonate baby bottles make up about 90% of the bottle market. The most common polycarbonate bottle is Avent’s Natural Feeding Bottle and Dr. Brown’s Natural flow. But other major baby product companies like Playtex and Gerber also make polycarbonate bottles.

See our website at baby411.com for pictures of bottles containing BPA:

http://www.windsorpeak.com/babybargains/BPAbottles.html

Here are the alternatives that are BPA-free:

• Use glass bottles. Obviously, there is a risk of injury to baby or mom if the bottle is dropped, so glass isn’t a perfect alternative.

• Use bottles made of opaque plastic. These bottles (made of polyethylene or polypropylene) do not contain BPA.

• Consider a BPA-free plastic bottle. Born Free makes a BPA-free clear plastic bottle (Newbornfree.com) sold at Whole Foods. But these cost about $10 each, twice the price of Avent bottles.

• Use a drop-in system. For example the Playtex Drop-in System is BPA free (that is, the bottle liners do not contain BPA). Avent’s Tempo liners are another example.

Pictures of BPA-free bottles are here:

http://www.windsorpeak.com/babybargains/BPAFREEbottles.html


Q. Is there a way to tell if a bottle has BPA?

A. Unfortunately, it isn’t easy. Here’s a general guide:

BAD:
• Bottles that have a #7 on their recycling label most likely are made of polycarbonate (and contain BPA).

GOOD:
• Bottles that have a #2, #4 , #5 are made of polyethylene or polypropylene—these do NOT have BPA.

We call on the government to require disclosure of which bottles have BPA, so consumers can make an informed choice.

Q. What about sippy cups?

A. Basically, the same advice applies: avoid those made of polycarbonate. Sippy cups made of opaque plastic are fine.

Q. What about breast-pump collection bottles?

A. Again, avoid polycarbonate bottles (Avent Isis is an example) and choose BPA-free options. For example, all of Medela’s bottles are made from BPA-free plastics.

Q. I just bought $50 worth of Avent bottles. Are you saying I should throw them out?

A. Yes. We realize this in an inconvenience—but if you think about it, buying replacement bottles would run only $50 to $100. When it comes to safety, we think this is a worthwhile investment.

What if you don’t want to give up your polycarbonate bottles? While we don’t recommend that option, to lower the amount of BPA that may leach out, avoid heating the bottles in a dishwasher, microwave, or sterilizer. And, toss out any baby bottles that are cracked. Again, we believe the safest course is to replace the bottles with BPA-free alternatives.

Infant TV and language skills

A study published in the August issue of Journal of Pediatrics reports that children under 16 months of age who watch at least one hour a day of baby-geared DVD's have poorer language skills than those who don't.

As we've pointed out in both Baby 411 and Toddler 411, the American Academy of Pediatrics discourages ANY screen time (TV, DVD's, computers) for young children under age two. The reason: it is not beneficial and may be detrimental.

While this study doesn't even try to find the reason for this statistical significance, it does point out some valid concerns:
1. Are parents using TV as a babysitter and not engaging with their child?
2. Are parents being led to believe that their baby will be smarter by watching so-called "educational" or "developmentally appropriate" DVD's?
3. Or does the programming itself have a negative effect on development?

75% of the top-selling infant videos make claims that their products are educational however, there are no studies that prove these claims--and now there is one that negates it.

Our take-home message for this latest study: let the buyer beware.